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Hausman-Kedem M, Widjaja E, Vieira Neto RJ, Pope E, Lara-Corrales I, Dlamini N, Macgregor D, Pulcine E, Deveber G, Moharir M. Long-term clinical and radiological trajectories of craniocervical vasculopathy in children with PHACE syndrome. Dev Med Child Neurol 2024. [PMID: 38597798 DOI: 10.1111/dmcn.15916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 02/15/2024] [Accepted: 02/26/2024] [Indexed: 04/11/2024]
Abstract
AIM To describe the rates of stroke and craniocervical vasculopathy progression in children with posterior fossa malformations, hemangioma, arterial anomalies, coarctation of the aorta/cardiac defects, and eye abnormalities (PHACE) syndrome. METHOD A single-center, retrospective natural history study of children with PHACE syndrome. Clinical and sequential neuroimaging data were reviewed to study the characteristics and progression of vasculopathy and calculate the rates of arterial ischemic stroke (AIS) and transient ischemic stroke (TIA). Vasculopathy progression was defined as worsening or new vascular findings on follow-up magnetic resonance angiography. RESULTS Thirty-four children with cerebrovascular abnormalities at the PHACE syndrome diagnosis were studied (age range = 2 to 18 years, 85% females). Median age at the initial diagnosis was 5.5 months (interquartile range = 1-52 months); median age at the last follow-up was 8 years 6 months (range = 2-18 years). Overall, 10 (29%) patients had radiological progression of their vasculopathy, with a cumulative progression-free rate of 73% (95% confidence interval [CI] = 0.57-0.89), and a cumulative TIA-free and AIS-free rate of 87% (95% CI = 0.745-0.99). Vasculopathy was continuously progressive in six patients (18%) at the last follow-up. Three patients (9%) had TIA and all had progressive vasculopathy. One patient had presumed perinatal AIS at the initial PHACE diagnosis, while no other patient experienced an AIS during the follow-up. INTERPRETATION In children with PHACE syndrome, craniocervical vasculopathy is non-progressive and asymptomatic in the majority of cases. The risk of ischemic stroke in these children is very low. Larger and prospective studies are necessary to confirm these findings.
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Affiliation(s)
- Moran Hausman-Kedem
- Tel Aviv Sourasky Medical Center, Pediatric Neurology Institute, Dana-Dwek Children's Hospital, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Elysa Widjaja
- Division of Neuroradiology, Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Medical Imaging, Ann & Robert H. Lurie Children's Hospital, Chicago, USA
| | - Ronan J Vieira Neto
- Department of Pediatric Neurology, Hospital Sírio-Libanês, São Paulo, Brazil
| | - Elena Pope
- Division of Dermatology, Department of Pediatrics, Hospital for Sick Children, Toronto, ON, Canada
| | - Irene Lara-Corrales
- Division of Dermatology, Department of Pediatrics, Hospital for Sick Children, Toronto, ON, Canada
| | - Nomazulu Dlamini
- Children's Stroke Program, Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Daune Macgregor
- Children's Stroke Program, Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Elizabeth Pulcine
- Children's Stroke Program, Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Gabrielle Deveber
- Children's Stroke Program, Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Mahendranath Moharir
- Children's Stroke Program, Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada
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Braun M, Frieden IJ, Siegel DH, George E, Hess CP, Fox CK, Chamlin SL, Drolet BA, Metry D, Pope E, Powell J, Holland K, Ulschmid C, Liang MG, Barry KK, Ho T, Cotter C, Baselga E, Bosquez D, Jain SN, Bui JK, Lara-Corrales I, Funk T, Small A, Baghoomian W, Yan AC, Treat JR, Hogrogian GS, Huang C, Haggstrom A, List M, McCuaig CC, Barrio V, Mancini AJ, Lawley LP, Grunnet-Satcher K, Horii KA, Newell B, Nopper A, Garzon MC, Scollan ME, Mathes EF. Multicenter Study of Long-Term Outcomes and Quality of Life in PHACE Syndrome after Age 10. J Pediatr 2024; 267:113907. [PMID: 38218370 DOI: 10.1016/j.jpeds.2024.113907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/23/2023] [Accepted: 01/09/2024] [Indexed: 01/15/2024]
Abstract
OBJECTIVE To characterize long-term outcomes of PHACE syndrome. STUDY DESIGN Multicenter study with cross-sectional interviews and chart review of individuals with definite PHACE syndrome ≥10 years of age. Data from charts were collected across multiple PHACE-related topics. Data not available in charts were collected from patients directly. Likert scales were used to assess the impact of specific findings. Patient-Reported Outcomes Measurement Information System (PROMIS) scales were used to assess quality of life domains. RESULTS A total of 104/153 (68%) individuals contacted participated in the study at a median of 14 years of age (range 10-77 years). There were infantile hemangioma (IH) residua in 94.1%. Approximately one-half had received laser treatment for residual IH, and the majority (89.5%) of participants were satisfied or very satisfied with the appearance. Neurocognitive manifestations were common including headaches/migraines (72.1%), participant-reported learning differences (45.1%), and need for individualized education plans (39.4%). Cerebrovascular arteriopathy was present in 91.3%, with progression identified in 20/68 (29.4%) of those with available follow-up imaging reports. Among these, 6/68 (8.8%) developed moyamoya vasculopathy or progressive stenoocclusion, leading to isolated circulation at or above the level of the circle of Willis. Despite the prevalence of cerebrovascular arteriopathy, the proportion of those with ischemic stroke was low (2/104; 1.9%). PROMIS global health scores were lower than population norms by at least 1 SD. CONCLUSIONS PHACE syndrome is associated with long-term, mild to severe morbidities including IH residua, headaches, learning differences, and progressive arteriopathy. Primary and specialty follow-up care is critical for PHACE patients into adulthood.
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Affiliation(s)
- Mitchell Braun
- University of California San Francisco, School of Medicine, San Francisco, CA; Department of Dermatology, University of California San Francisco, San Francisco, CA
| | - Ilona J Frieden
- Department of Dermatology, University of California San Francisco, San Francisco, CA
| | - Dawn H Siegel
- Department of Dermatology, Stanford University, Palo Alto, CA
| | - Elizabeth George
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA
| | - Christopher P Hess
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA
| | - Christine K Fox
- Department of Neurology and Pediatrics, University of California San Francisco, San Francisco, CA
| | - Sarah L Chamlin
- Department of Dermatology, Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Beth A Drolet
- Department of Dermatology, University of Wisconsin Madison, Madison, WI
| | - Denise Metry
- Department of Dermatology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX
| | - Elena Pope
- Division of Pediatric Dermatology, Hospital for Sick Children, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Julie Powell
- Division of Dermatology, Department of Pediatrics, Sainte-Justine University Hospital Center, University of Montreal, Montreal, Quebec, Canada
| | - Kristen Holland
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, WI
| | - Caden Ulschmid
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, WI
| | - Marilyn G Liang
- Department of Dermatology, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Kelly K Barry
- Department of Dermatology, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Tina Ho
- Department of Dermatology, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Chantal Cotter
- Department of Dermatology, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Eulalia Baselga
- Department of Dermatology, Hospital de la Sant Pau, Barcelona, Spain
| | - David Bosquez
- Department of Dermatology, Hospital de la Sant Pau, Barcelona, Spain
| | | | - Jordan K Bui
- Department of Dermatology, Stanford University, Palo Alto, CA
| | - Irene Lara-Corrales
- Division of Pediatric Dermatology, Hospital for Sick Children, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Tracy Funk
- Departments of Dermatology and Pediatrics, Oregon Health & Science University, Portland, OR
| | - Alison Small
- Departments of Dermatology and Pediatrics, Oregon Health & Science University, Portland, OR
| | - Wenelia Baghoomian
- Departments of Dermatology and Pediatrics, Oregon Health & Science University, Portland, OR
| | - Albert C Yan
- Department of Pediatrics and Dermatology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - James R Treat
- Department of Pediatrics and Dermatology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Griffin Stockton Hogrogian
- Department of Pediatrics and Dermatology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Charles Huang
- Department of Pediatrics and Dermatology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Anita Haggstrom
- Department of Dermatology, Indiana University School of Medicine, Indianapolis, IN
| | - Mary List
- Department of Dermatology, Indiana University School of Medicine, Indianapolis, IN
| | - Catherine C McCuaig
- Division of Dermatology, Department of Pediatrics, Sainte-Justine University Hospital Center, University of Montreal, Montreal, Quebec, Canada
| | - Victoria Barrio
- Department of Dermatology, Rady Children's Hospital, University of California San Diego, San Diego, CA
| | - Anthony J Mancini
- Department of Dermatology, Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Leslie P Lawley
- Department of Dermatology, Emory University School of Medicine, Atlanta, GA
| | | | - Kimberly A Horii
- Division of Dermatology, Children's Mercy Hospital and Clinics, Kansas City, MO
| | - Brandon Newell
- Division of Dermatology, Children's Mercy Hospital and Clinics, Kansas City, MO
| | - Amy Nopper
- Division of Dermatology, Children's Mercy Hospital and Clinics, Kansas City, MO
| | - Maria C Garzon
- Department of Dermatology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Margaret E Scollan
- Department of Dermatology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Erin F Mathes
- Department of Dermatology, University of California San Francisco, San Francisco, CA.
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Kheireddin AS, Pronin IN, Yakovlev SB, Belousova OB, Kaftanov AN, Vinogradov EV. [Pathological tortuosity of intracranial arteries (pure arterial malformation) - diagnosis and management tactics]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2024; 88:14-22. [PMID: 38549406 DOI: 10.17116/neiro20248802114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
BACKGROUND Tortuosity of intracranial arteries is rare and usually mistaken for arteriovenous malformations. In the world literature, the term «pure arterial malformations» is used to refer to this disease. OBJECTIVE To summarize the experience of the Burdenko Neurosurgery Center on diagnosis of intracranial artery tortuosity, management and treatment of these patients, as well as to review appropriate literature data. MATERIAL AND METHODS Tortuosity of intracranial arteries was detected in 11 patients (8 women and 3 men) aged 7-48 years who underwent outpatient or inpatient examination and treatment at the Burdenko Neurosurgery Center between 2009 and 2022. We analyzed angiographic, clinical and follow-up data of these patients, as well as appropriate literature data. RESULTS According to angiography data, all patients had moderate dilatation, elongation and tortuosity of intracranial arteries without signs of arteriovenous shunting. The most common finding was tortuosity of several segments of internal carotid artery (5 cases). Lesion of PCA, PComA, MCA and ACA was less common. In 7 cases, the walls of the deformed vessels had calcified zones. In two cases, there were saccular aneurysms in the walls of the tortuous vessels. In one case, tortuosity was combined with kinking of the left subclavian artery, in another one - tortuosity of C1 segment of the right ICA. No patient had specific clinical manifestations. The follow-up period was 1-10 years in 7 patients. There were no changes in structure of tortuosity or appearance of new aneurysms. CONCLUSION Tortuosity of intracranial arteries is an extremely rare disease with the highest incidence in young women. This abnormality has no specific clinical manifestations and does not require surgical or conservative treatment. Tortuosity of intracranial arteries should be differentiated from arterial dolichoectasia, fusiform aneurysms and AVMs.
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Affiliation(s)
| | - I N Pronin
- Burdenko Neurosurgical Center, Moscow, Russia
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Beidas T, Jazzar Y, Shadid A, Alhammad A, Mohajer KA, Abduljabbar AM. Propranolol for the Treatment of Hemangioma in PHACE Syndrome: A Case Report. Cureus 2023; 15:e44036. [PMID: 37638272 PMCID: PMC10457131 DOI: 10.7759/cureus.44036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2023] [Indexed: 08/29/2023] Open
Abstract
Oral propranolol is commonly used as a first-line treatment for infantile hemangioma. However, its use in PHACE (posterior fossa anomalies, hemangioma, arterial anomalies, cardiac anomalies, and eye anomalies) syndrome raises concerns that it might exacerbate the patient's risk of stroke. Here, we report the case of a four-month-old premature girl with PHACE syndrome, who presented with a large hemangioma involving the left side of her face, following the V1+V2+V3 distribution, including the upper lip, left ear, and left eye. This condition was successfully treated with propranolol, and no adverse side effects were reported.
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Affiliation(s)
- Tala Beidas
- Dermatology, King Saud Medical City, Riyadh, SAU
| | - Yara Jazzar
- Dermatology, Alfaisal University College of Medicine, Riyadh, SAU
| | - Asem Shadid
- Dermatology, King Fahad Medical City, Riyadh, SAU
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Habib M, Manilha R, Khan N. Management of PHACES syndrome: Risk of stroke and its prevention from a neurosurgical perspective. Eur J Paediatr Neurol 2020; 26:39-45. [PMID: 32276757 DOI: 10.1016/j.ejpn.2020.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 03/10/2020] [Accepted: 03/14/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVES A multidisciplinary approach for PHACES is essential. A meticulous diagnostic and treatment protocol for PHACES patients with cerebrovascular anomalies within the intermediate and high risk strata for ischemic stroke is presented. We also differentiate the vasculopathy associated with PHACES syndrome from moyamoya angiopathy. METHODS Medical records and radiological imaging were reviewed. After initial magnetic resonance imaging/angiography (MRI/MRA), H215O-PET scan (baseline and Acetazolamide challenge) was performed in three patients and 6-vessel cerebral angiography was performed in two patients. Two patients with significant intracranial cerebrovascular anomalies underwent cerebral revascularization. RESULTS Each patient presented with a facial hemangioma at birth and additional cerebrovascular anomalies ranging from hypoplasia to steno-occlusive changes of intracranial cerebral arteries. Additional involvement of the cardiovascular system was observed in two patients. Additional to MRI/MRA, a H215O-PET helped stratify the three patients into intermediate (n=1) and high risk groups (n=2). The high-risk group patients underwent individualized cerebral revascularization for future stroke prevention. The patient in intermediate risk group will be followed. Cerebrovascular angiopathy seen in all patients was typical for PHACES without moyamoya and was not progressive at follow-up. CONCLUSIONS Patients within the intermediate and high-risk strata for ischemic stroke must undergo a 6-vessel cerebral angiography and further hemodynamic evaluation to indicate need for cerebral revascularization to prevent ischemic stroke. Non-progressive vasculopathy associated with PHACES can itself be hemodynamically relevant for neurosurgical intervention. This vasculopathy is distinct from moyamoya angiopathy, which can occur in conjunction with PHACES, resulting in concurrent progressive vasculopathy that would otherwise be absent.
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Affiliation(s)
- Mikaeel Habib
- Moyamoya Center, Division of Pediatric Neurosurgery, University Children's Hospital, Zürich, Switzerland
| | - Rui Manilha
- Moyamoya Center, Division of Pediatric Neurosurgery, University Children's Hospital, Zürich, Switzerland
| | - Nadia Khan
- Moyamoya Center, Division of Pediatric Neurosurgery, University Children's Hospital, Zürich, Switzerland.
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6
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Moyamoya angiopathy in PHACE syndrome not associated with RNF213 variants. Childs Nerv Syst 2019; 35:1231-1237. [PMID: 31037424 DOI: 10.1007/s00381-019-04145-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 04/02/2019] [Indexed: 10/26/2022]
Abstract
Moyamoya angiopathy is a rare vasculopathy with stenosis and/or occlusion of bilateral intracranial parts of internal carotid arteries and/or proximal parts of middle and anterior cerebral arteries. PHACE syndrome is characterized by large segmental hemangiomas in the cervical-facial region. Both conditions are known to be associated in rare cases. Recently, it was discussed in the literature that RNF213 variants could be etiologically involved in this association. Here, we describe a childhood case with this rare co-occurrence in which we did not identify any rare RNF213 variant. The clinical and genetic backgrounds are discussed.
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7
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The cerebellar "tilted telephone receiver sign" enables prenatal diagnosis of PHACES syndrome. Eur J Paediatr Neurol 2018; 22:900-909. [PMID: 30209013 DOI: 10.1016/j.ejpn.2018.08.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 08/25/2018] [Accepted: 08/27/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To describe a unique posterior fossa neuroimaging characteristic of prenatal PHACES syndrome (PS): unilateral cerebellar hypoplasia (UCH) and ipsilateral posterior fossa (PF) cyst communicating with an asymmetrically distended 4th ventricle. METHODS The registries of seven prenatal diagnosis centers were searched for cases with PF findings and a postnatal diagnosis of PS. All records were evaluated for ultrasound and MRI findings and the postnatal outcome. PS was diagnosed after birth according to the consensus statement on diagnostic criteria for PS from 2009. The imaging findings of the PS fetuses were compared to a group of consecutive cases with fetal UCH, whose postnatal diagnosis was not PS. RESULTS The PS group included 10 fetuses. All were referred due to UCH accompanied by an ipsilateral retrocerebellar cyst. All pregnancies resulted in livebirths, all newborns had a large segmental facial hemangioma. In all PS fetuses the affected cerebellar hemisphere was upwardly displaced by an ipsilateral PF cyst communicating with an asymmetrically distended 4th ventricle. An upwardly rotated and deviated vermis merged with the contralateral cerebellar peduncles forming an elongated oblique connection between the cerebellar hemispheres, resulting in a unique cerebellar shape, "a tilted telephone receiver sign" (TTRS), on the coronal plane through the upper vermis.The non-PS group included 11 fetuses with UCH: clastic cerebellar lesions (8) and a unilateral PF arachnoid cyst (3). The TTRS was not depicted in any of them (p < 0.0005). CONCLUSIONS The cerebellar TTRS is a specific fetal imaging feature of PHACES syndrome enabling its prenatal diagnosis.
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Goyal P, Mangla R, Gupta S, Malhotra A, Almast J, Sapire J, Kolar B. Pediatric Congenital Cerebrovascular Anomalies. J Neuroimaging 2018; 29:165-181. [DOI: 10.1111/jon.12575] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 10/11/2018] [Accepted: 10/13/2018] [Indexed: 11/29/2022] Open
Affiliation(s)
- Pradeep Goyal
- Department of Radiology; St. Vincent's Medical Center; Bridgeport CT
| | - Rajiv Mangla
- Department of Radiology; SUNY Upstate Medical University; Syracuse NY
| | - Sonali Gupta
- Department of Medicine; St. Vincent's Medical Center; Bridgeport CT
| | - Ajay Malhotra
- Department of Radiology and Biomedical Imaging; Yale School of Medicine; New Haven CT
| | - Jeevak Almast
- Department of Radiology; University of Rochester Medical Center; Rochester NY
| | - Joshua Sapire
- Department of Radiology; St. Vincent's Medical Center; Bridgeport CT
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9
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Tortora D, Severino M, Accogli A, Martinetti C, Vercellino N, Capra V, Rossi A, Pavanello M. Moyamoya Vasculopathy in PHACE Syndrome: Six New Cases and Review of the Literature. World Neurosurg 2017; 108:291-302. [DOI: 10.1016/j.wneu.2017.08.176] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 08/26/2017] [Accepted: 08/28/2017] [Indexed: 11/26/2022]
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10
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Delgado N, Carroll JJ, Meyers PM. Concomitant carotid aplasia and basilar artery occlusion in a child with PHACES syndrome. BMJ Case Rep 2017; 2017:bcr-2017-221055. [PMID: 28814594 DOI: 10.1136/bcr-2017-221055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We report a case of an 8-year-old girl with posterior fossa abnormalities, haemangioma, arterial lesions, cardiac abnormalities or coarctation of the aorta and eye abnormalities syndrome with right carotid aplasia and complete basilar occlusion. The patient initially presented at 2.5 weeks of age with a growing right facial haemangioma involving segments 1, 3 and 4. Initial MRI at 2.5 weeks of age revealed an extraconal right orbital haemangioma without posterior fossa abnormalities and MR angiography (MRA) 3 weeks later showed right internal carotid aplasia. A follow-up MRA and cerebral angiography at 8 years of age revealed a complete occlusion of the basilar artery that was not appreciated on previous imaging. Neurological function remains normal, meeting all age-appropriate milestones.
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Affiliation(s)
- Noel Delgado
- Columbia University College of Physicians and Surgeons, New York, USA
| | - Jason J Carroll
- Department of Radiology, Columbia University College of Physicians and Surgeons, New York, USA
| | - Philip M Meyers
- Department of Radiology, Columbia University College of Physicians and Surgeons, New York, USA
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McVey MJ, Farlinger CM, Van Arsdell G, Armstrong D, Holtby H. Anesthesia for Complex Cardiovascular Surgery in a Patient With PHACES Syndrome and Review of the Literature. J Cardiothorac Vasc Anesth 2017; 31:1042-1047. [DOI: 10.1053/j.jvca.2016.07.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Indexed: 12/19/2022]
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12
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Garzon MC, Epstein LG, Heyer GL, Frommelt PC, Orbach DB, Baylis AL, Blei F, Burrows PE, Chamlin SL, Chun RH, Hess CP, Joachim S, Johnson K, Kim W, Liang MG, Maheshwari M, McCoy GN, Metry DW, Monrad PA, Pope E, Powell J, Shwayder TA, Siegel DH, Tollefson MM, Vadivelu S, Lew SM, Frieden IJ, Drolet BA. PHACE Syndrome: Consensus-Derived Diagnosis and Care Recommendations. J Pediatr 2016; 178:24-33.e2. [PMID: 27659028 PMCID: PMC6599593 DOI: 10.1016/j.jpeds.2016.07.054] [Citation(s) in RCA: 144] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 05/23/2016] [Accepted: 07/29/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Maria C. Garzon
- Departments of Dermatology and Pediatrics, Columbia University, New York, NY
| | - Leon G. Epstein
- Departments of Pediatrics and Neurology, The Ann and Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Geoffrey L. Heyer
- Departments of Pediatrics and Neurology, Nationwide Children’s Hospital, The Ohio State University, Columbus, OH
| | - Peter C. Frommelt
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
| | - Darren B. Orbach
- Division of Neurointerventional Radiology, Boston Children’s Hospital, Boston, MA
| | - Adriane L. Baylis
- Department of Plastic Surgery, Nationwide Children’s Hospital, Columbus, OH
| | - Francine Blei
- Department of Pediatrics/ Hematology, Lenox Hill Hospital, Northwell Health, Great Neck, NY
| | | | - Sarah L. Chamlin
- Division of Pediatric Dermatology, The Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL
| | - Robert H. Chun
- Department of Otolaryngology, Medical College of Wisconsin, Milwaukee, WI
| | - Christopher P. Hess
- Departments of Radiology and Neurology, University of California, San Francisco, San Francisco, CA
| | - Shawna Joachim
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, WI
| | | | - Wendy Kim
- Division of Dermatology, Departments of Medicine and Pediatrics, Loyola University Medical Center, Maywood, IL
| | | | - Mohit Maheshwari
- Department of Radiology, Medical College of Wisconsin, Milwaukee, WI
| | - Garrett N. McCoy
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, WI
| | - Denise W. Metry
- Department of Dermatology, Texas Children’s Baylor, Houston, TX
| | - Priya A. Monrad
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI
| | - Elena Pope
- Section of Pediatric Dermatology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Julie Powell
- Department of Dermatology, University of Montreal, Montreal, Québec, Canada
| | | | - Dawn H. Siegel
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, WI
| | | | - Sudhakar Vadivelu
- Department of Neurosurgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Sean M. Lew
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI
| | - Ilona J. Frieden
- Department of Dermatology, University of California, San Francisco, San Francisco, CA
| | - Beth A. Drolet
- Departments of Dermatology and Pediatrics, Medical College of Wisconsin, Milwaukee, WI
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13
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PHACE syndrome is associated with intracranial cavernous malformations. Childs Nerv Syst 2016; 32:1463-9. [PMID: 27125518 DOI: 10.1007/s00381-016-3097-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Accepted: 04/18/2016] [Indexed: 10/25/2022]
Abstract
INTRODUCTION PHACE syndrome is a neurocutaneous disorder involving large facial hemangiomas in association with posterior fossa abnormalities, cerebral arterial anomalies, cardiac defects, and eye abnormalities. A recent consensus statement has delineated criteria necessary for the diagnosis of PHACE syndrome. Extracutaneous manifestations of PHACE syndrome predominately affect the cerebrovascular system. To date, there are no reports of cerebral cavernous malformations (CCMs) in children with PHACE syndrome. METHODS We reviewed the charts of children admitted to the Children''s Hospital of Pittsburgh who met criteria for PHACE syndrome, and evaluated neuroimaging for cerebrovascular abnormalities, including the finding of CCMs. RESULTS Six children met criteria for PHACE syndrome at our institution over a 10-year period. All children were female. All children had cerebrovascular abnormalities sufficient to meet major criteria for diagnosis. Four children (66.7 %) were found incidentally to have CCMs; all lesions measured less than 5 mm at the time of diagnosis and were asymptomatic. CONCLUSION At present, CCMs are not listed among the diagnostic criteria for PHACE syndrome, and they have not previously been reported in association with PHACE syndrome. Hypoxic injury in utero may be the common denominator in the pathogenesis of many of the abnormalities already accepted in the criteria for PHACE syndrome and the formation of CCMs. In the setting of PHACE syndrome, we encourage clinicians to evaluate children for CCMs, which are readily apparent on the already-recommended screening MRIs.
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Staged Repair of Complete Sternal Cleft and Interrupted Aortic Arch Associated With PHACES Syndrome in a Very Low Birth Weight Infant. Int Surg 2016. [DOI: 10.9738/intsurg-d-15-00228.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Posterior fossa malformations, hemangiomas, arterial anomalies, cardiac defects, eye abnormalities, and sternal malformations' (PHACES) syndrome comprises various defects that require a concrete therapeutic plan. Herein, we report a case of a very low birth weight infant with PHACES syndrome presenting complete sternal cleft, interrupted aortic arch with ventricular septal defect, and absence of communicating cerebral arteries. Due to the infant's very low birth weight, we planned staged surgery for this complex disease. First, bilateral pulmonary artery banding was performed to improve unstable hemodynamics. Then, after sufficient body weight was obtained, aortic arch and intracardiac repair was done. However, when the tracheal tube was removed 2 weeks after surgery, the patient could not breathe well due to paradoxical chest movement related to complete sternal cleft. Consequently, to improve chest wall compliance, the upper sternum was constructed with dislocated ribs. After these treatments, the patient gained adequate weight and was in stable condition. Staged surgical treatment of sternal cleft and congenital heart defects is a potential therapeutic option for PHACES syndrome, particularly in very low birth weight infants with complex cardiovascular disease.
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Caragher SP, Scott JP, Siegel DH, Mitchell ME, Frommelt PC, Drolet BA. Aortic arch repair in children with PHACE syndrome. J Thorac Cardiovasc Surg 2016; 152:709-17. [PMID: 27160940 DOI: 10.1016/j.jtcvs.2016.03.082] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 03/21/2016] [Accepted: 03/27/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND PHACE syndrome is characterized by infantile hemangioma and developmental abnormalities of the brain, arteries of head and neck, and aortic arch. METHODS We retrospectively reviewed The PHACE Syndrome International Clinical Registry to identify children with PHACE who had operative repair of aortic arch obstruction at Children's Hospital of Wisconsin. RESULTS Seven patients (median 11 months, range 1 week-6 years) with PHACE required aortic arch reconstruction from 1996 to 2015. All needed complex surgical approaches (4 conduit grafts, 2 patch aortoplasties, 1 subclavian flap) to relieve the obstruction because of long-segment transverse and proximal descending aortic arch dysplasia that included multiple areas of stricture with adjacent aneurysmal dilatation. Aberrant origin of a subclavian artery was found in 6 of 7. The 3 children who had surgery after age 1 showed significant progression of the arch obstruction and/or adjacent aneurysmal segment dilatation after their initial infant evaluation. No deaths or perioperative complications occurred despite associated cerebrovascular arterial dysplasia in 5 of 7. Recurrent arch obstruction developed in 3 of 7 at an intermediate follow-up interval of 6.2 years (2 had interposition graft replacement at 8 and 11 years due to somatic growth; 1 had repeat patch aortoplasty 11 months after initial repair secondary to recurrent stenosis). CONCLUSIONS Extensive aortic arch reconstruction is commonly required in children with PHACE syndrome and coarctation due to the bizarre nature of the obstruction. Complete preoperative imaging is needed to fully characterize the aortic and cerebrovascular arterial anomalies. Recurrent obstruction is common given the non-native tissue techniques needed to relieve the arch anomaly.
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Affiliation(s)
- Seamus P Caragher
- Department of Dermatology and Pediatrics, Medical College of Wisconsin, Milwaukee, Wis
| | - John P Scott
- Department of Anesthesiology and Pediatrics, Medical College of Wisconsin, Milwaukee, Wis
| | - Dawn H Siegel
- Department of Dermatology and Pediatrics, Medical College of Wisconsin, Milwaukee, Wis
| | - Michael E Mitchell
- Department of Cardiovascular Surgery and Pediatrics, Medical College of Wisconsin, Milwaukee, Wis
| | - Peter C Frommelt
- Department of Cardiology and Pediatrics, Medical College of Wisconsin, Milwaukee, Wis
| | - Beth A Drolet
- Department of Dermatology and Pediatrics, Medical College of Wisconsin, Milwaukee, Wis.
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Winter PR, Itinteang T, Leadbitter P, Tan ST. PHACE syndrome--clinical features, aetiology and management. Acta Paediatr 2016; 105:145-53. [PMID: 26469095 DOI: 10.1111/apa.13242] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 09/25/2015] [Accepted: 10/12/2015] [Indexed: 02/06/2023]
Abstract
UNLABELLED PHACE syndrome comprises a spectrum of anomalies including posterior fossa malformations, haemangioma, arterial anomalies, cardiac defects and eye anomalies. PHACE should be considered in any patient with a large facial segmental infantile haemangioma (IH), and multidisciplinary management is crucial. Low-dose propranolol is effectively for the treatment of IH associated with PHACE syndrome. Recent evidence suggests IH is comprised of mesoderm-derived haemogenic endothelium. CONCLUSION The embryonic developmental anomaly nature of IH provides an insight into the origin of PHACE syndrome.
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Affiliation(s)
| | | | - Phillip Leadbitter
- Gillies McIndoe Research Institute; Wellington New Zealand
- Centre for the Study & Treatment of Vascular Birthmarks; Wellington Regional Plastic; Maxillofacial & Burns Unit; Wellington New Zealand
- Department of Paediatrics; Hutt Hospital; Wellington New Zealand
| | - Swee T. Tan
- Gillies McIndoe Research Institute; Wellington New Zealand
- Centre for the Study & Treatment of Vascular Birthmarks; Wellington Regional Plastic; Maxillofacial & Burns Unit; Wellington New Zealand
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Jack AS, Chow MM, Fiorillo L, Chibuk T, Yager JY, Mehta V. Bilateral pial synangiosis in a child with PHACE syndrome. J Neurosurg Pediatr 2016; 17:70-5. [PMID: 26405843 DOI: 10.3171/2015.5.peds1578] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The acronym PHACE has been used to denote a constellation of abnormalities: posterior fossa anomalies, facial hemangiomas, arterial anomalies, cardiac anomalies, and eye abnormalities. Approximately 30% of patients with large facial hemangiomas have PHACE syndrome, with the vast majority having intracranial arteriopathy. Few reports characterize neurological deterioration from this intracranial arteriopathy, and even fewer report successful treatment thereof. The authors report on a case of a child with PHACE syndrome who presented with an ischemic stroke from a progressive intracranial arteriopathy and describe her successful treatment with bilateral pial synangiosis. An 8-month old girl diagnosed with PHACE syndrome was found to have bilateral internal carotid artery stenosis. Although initially asymptomatic, a few months after diagnosis she suffered a right frontal and parietal stroke. MRI and cerebral angiography investigations demonstrated progressive intracranial arterial stenosis and occlusion. The patient then underwent indirect cerebral revascularization surgery. At 2-year follow-up, she exhibited clinical improvement with persistent speech and motor developmental delay. Follow-up MRI and cerebral angiography showed no new ischemic events and robust extensive vascular collateralization from surgery. PHACE syndrome is an uncommon disease, and affected patients often have cerebral arteriopathy. Although the underlying natural history of cerebral arteriopathy in PHACE remains unclear, cerebral revascularization may represent a potential therapy for symptomatic patients.
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Affiliation(s)
- Andrew S Jack
- Division of Neurosurgery, Department of Surgery, and
| | | | | | | | - Jerome Y Yager
- Pediatric Neurology, Department of Pediatrics, Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Vivek Mehta
- Division of Neurosurgery, Department of Surgery, and
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Sethuraman G, Yenamandra VK, Gupta V. Management of infantile hemangiomas: current trends. J Cutan Aesthet Surg 2014; 7:75-85. [PMID: 25136206 PMCID: PMC4134656 DOI: 10.4103/0974-2077.138324] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Infantile hemangiomas (IH) are common vascular tumours. IH have a characteristic natural course. They proliferate rapidly during the early infantile period followed by a period of gradual regression over several years. Most of the uncomplicated IH undergo spontaneous involution, with a small proportion of cases requiring intervention. These are children with IH in life-threatening locations, local complications like haemorrhage, ulceration and necrosis and functional or cosmetic disfigurements. Systemic corticosteroids have been the first line of treatment for many years. Recently, non-selective beta-blockers, such as oral propranalol and topical timolol, have emerged as promising and safer therapies. Other treatment options include interferon α and vincristine which are reserved for life-threatening haemangiomas that are unresponsive to conventional therapy. This review mainly focuses on the current trends and evidence-based approach in the management of IH.
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Affiliation(s)
- Gomathy Sethuraman
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - Vamsi K Yenamandra
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - Vishal Gupta
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
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Ictus trombótico en paciente de 35 años ¿criptogénico, malformación vascular o trombosis completa arterial? HIPERTENSION Y RIESGO VASCULAR 2014. [DOI: 10.1016/j.hipert.2014.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Tangtiphaiboontana J, Hess CP, Bayer M, Drolet BA, Nassif LM, Metry DW, Barkovich AJ, Frieden IJ, Fullerton HJ. Neurodevelopmental abnormalities in children with PHACE syndrome. J Child Neurol 2013; 28:608-14. [PMID: 22805249 DOI: 10.1177/0883073812450073] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Prior case reports have identified neurodevelopmental abnormalities in children with PHACE syndrome, a neurocutaneous disorder first characterized in 1996. In this multicenter, retrospective study of a previously identified cohort of 93 children diagnosed with PHACE syndrome from 1999 to 2010, 29 children had neurologic evaluations at ≥ 1 year of age (median age: 4 years, 2 months). In all, 44% had language delay, 36% gross motor delay, and 8% fine motor delay; 52% had an abnormal neurological exam, with speech abnormalities as the most common finding. Overall, 20 of 29 (69%) had neurodevelopmental abnormalities. Cerebral, but not posterior fossa, structural abnormalities were identified more often in children with abnormal versus normal neurodevelopmental outcomes (35% vs. 0%, P = .04). Neurodevelopmental abnormalities in young children with PHACE syndrome referred to neurologists include language and gross motor delay, while fine motor delay is less frequent. Prospective studies are needed to understand long-term neurodevelopmental outcomes.
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Chad L, Dubinski W, Hawkins C, Pope E, Bernstein S, Chiasson D. Postmortem vascular pathology in PHACES syndrome: a case report. Pediatr Dev Pathol 2012; 15:507-10. [PMID: 22901051 DOI: 10.2350/12-05-1203-cr.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This case describes the clinical course and autopsy findings of a 5-year-old girl with PHACES syndrome. While the etiopathogenesis of this condition is not yet understood, the pathological changes documented support the concept that the primary defect in PHACES syndrome is an arteriopathy.
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Affiliation(s)
- Lauren Chad
- Department of Paediatrics, The University of Toronto, Toronto, Ontario, Canada.
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Siegel DH, Tefft KA, Kelly T, Johnson C, Metry D, Burrows P, Pope E, Cordisco M, Holland KE, Maheshwari M, Keith P, Garzon M, Hess C, Frieden IJ, Fullerton HJ, Drolet BA. Stroke in Children With Posterior Fossa Brain Malformations, Hemangiomas, Arterial Anomalies, Coarctation of the Aorta and Cardiac Defects, and Eye Abnormalities (PHACE) Syndrome. Stroke 2012; 43:1672-4. [DOI: 10.1161/strokeaha.112.650952] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
PHACE is an acronym for posterior fossa brain malformations, hemangiomas, arterial anomalies, coarctation of the aorta and cardiac defects, and eye abnormalities. Several case reports of arterial ischemic stroke (AIS) in individuals with PHACE have been published, but risk factors for AIS in PHACE have not been clearly defined. The objective of this article is to review all cases of stroke in PHACE in children and describe clinical characteristics that may be associated with an increased risk of AIS.
Methods—
A literature and registry search was conducted to identify patients with PHACE who had experienced AIS. Data were analyzed to determine age of onset, presenting signs and symptoms, and clinical features among this cohort compared with PHACE without AIS.
Results—
Twenty-two individuals with PHACE and AIS were identified. Imaging of the arteries of the head and neck was reported in 20 of 22. Narrowing or nonvisualization of at least 1 great cerebral vessel was present in 19 of 20 and of those, 15 had ≥2 vessels involved. Aortic arch anomalies were reported in 13 of 22 individuals.
Conclusions—
Aplasia, hypoplasia, or occlusion of a major cerebral artery appears to be a significant risk factor for AIS in children with PHACE, especially when >1 vessel is involved or if there is coarctation of the aorta.
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Affiliation(s)
- Dawn H. Siegel
- From the Departments of Dermatology and Pediatrics (D.H.S., K.E.H., B.A.D.), Radiology (T.K., C.J., M.M.), and Dermatology (P.K.), Medical College of Wisconsin, Milwaukee, WI; the Department of Dermatology (K.A.T.), University of Kansas Medical Center, Kansas City, KS; the Department of Dermatology (D.M.), Baylor College of Medicine, Houston, TX; the Department of Diagnostic and Interventional Imaging (P.B.), University of Texas Health Sciences Center, Houston, TX; the Department of Dermatology and
| | - Kimberly A. Tefft
- From the Departments of Dermatology and Pediatrics (D.H.S., K.E.H., B.A.D.), Radiology (T.K., C.J., M.M.), and Dermatology (P.K.), Medical College of Wisconsin, Milwaukee, WI; the Department of Dermatology (K.A.T.), University of Kansas Medical Center, Kansas City, KS; the Department of Dermatology (D.M.), Baylor College of Medicine, Houston, TX; the Department of Diagnostic and Interventional Imaging (P.B.), University of Texas Health Sciences Center, Houston, TX; the Department of Dermatology and
| | - Teresa Kelly
- From the Departments of Dermatology and Pediatrics (D.H.S., K.E.H., B.A.D.), Radiology (T.K., C.J., M.M.), and Dermatology (P.K.), Medical College of Wisconsin, Milwaukee, WI; the Department of Dermatology (K.A.T.), University of Kansas Medical Center, Kansas City, KS; the Department of Dermatology (D.M.), Baylor College of Medicine, Houston, TX; the Department of Diagnostic and Interventional Imaging (P.B.), University of Texas Health Sciences Center, Houston, TX; the Department of Dermatology and
| | - Craig Johnson
- From the Departments of Dermatology and Pediatrics (D.H.S., K.E.H., B.A.D.), Radiology (T.K., C.J., M.M.), and Dermatology (P.K.), Medical College of Wisconsin, Milwaukee, WI; the Department of Dermatology (K.A.T.), University of Kansas Medical Center, Kansas City, KS; the Department of Dermatology (D.M.), Baylor College of Medicine, Houston, TX; the Department of Diagnostic and Interventional Imaging (P.B.), University of Texas Health Sciences Center, Houston, TX; the Department of Dermatology and
| | - Denise Metry
- From the Departments of Dermatology and Pediatrics (D.H.S., K.E.H., B.A.D.), Radiology (T.K., C.J., M.M.), and Dermatology (P.K.), Medical College of Wisconsin, Milwaukee, WI; the Department of Dermatology (K.A.T.), University of Kansas Medical Center, Kansas City, KS; the Department of Dermatology (D.M.), Baylor College of Medicine, Houston, TX; the Department of Diagnostic and Interventional Imaging (P.B.), University of Texas Health Sciences Center, Houston, TX; the Department of Dermatology and
| | - Patricia Burrows
- From the Departments of Dermatology and Pediatrics (D.H.S., K.E.H., B.A.D.), Radiology (T.K., C.J., M.M.), and Dermatology (P.K.), Medical College of Wisconsin, Milwaukee, WI; the Department of Dermatology (K.A.T.), University of Kansas Medical Center, Kansas City, KS; the Department of Dermatology (D.M.), Baylor College of Medicine, Houston, TX; the Department of Diagnostic and Interventional Imaging (P.B.), University of Texas Health Sciences Center, Houston, TX; the Department of Dermatology and
| | - Elena Pope
- From the Departments of Dermatology and Pediatrics (D.H.S., K.E.H., B.A.D.), Radiology (T.K., C.J., M.M.), and Dermatology (P.K.), Medical College of Wisconsin, Milwaukee, WI; the Department of Dermatology (K.A.T.), University of Kansas Medical Center, Kansas City, KS; the Department of Dermatology (D.M.), Baylor College of Medicine, Houston, TX; the Department of Diagnostic and Interventional Imaging (P.B.), University of Texas Health Sciences Center, Houston, TX; the Department of Dermatology and
| | - Maria Cordisco
- From the Departments of Dermatology and Pediatrics (D.H.S., K.E.H., B.A.D.), Radiology (T.K., C.J., M.M.), and Dermatology (P.K.), Medical College of Wisconsin, Milwaukee, WI; the Department of Dermatology (K.A.T.), University of Kansas Medical Center, Kansas City, KS; the Department of Dermatology (D.M.), Baylor College of Medicine, Houston, TX; the Department of Diagnostic and Interventional Imaging (P.B.), University of Texas Health Sciences Center, Houston, TX; the Department of Dermatology and
| | - Kristen E. Holland
- From the Departments of Dermatology and Pediatrics (D.H.S., K.E.H., B.A.D.), Radiology (T.K., C.J., M.M.), and Dermatology (P.K.), Medical College of Wisconsin, Milwaukee, WI; the Department of Dermatology (K.A.T.), University of Kansas Medical Center, Kansas City, KS; the Department of Dermatology (D.M.), Baylor College of Medicine, Houston, TX; the Department of Diagnostic and Interventional Imaging (P.B.), University of Texas Health Sciences Center, Houston, TX; the Department of Dermatology and
| | - Mohit Maheshwari
- From the Departments of Dermatology and Pediatrics (D.H.S., K.E.H., B.A.D.), Radiology (T.K., C.J., M.M.), and Dermatology (P.K.), Medical College of Wisconsin, Milwaukee, WI; the Department of Dermatology (K.A.T.), University of Kansas Medical Center, Kansas City, KS; the Department of Dermatology (D.M.), Baylor College of Medicine, Houston, TX; the Department of Diagnostic and Interventional Imaging (P.B.), University of Texas Health Sciences Center, Houston, TX; the Department of Dermatology and
| | - Phillip Keith
- From the Departments of Dermatology and Pediatrics (D.H.S., K.E.H., B.A.D.), Radiology (T.K., C.J., M.M.), and Dermatology (P.K.), Medical College of Wisconsin, Milwaukee, WI; the Department of Dermatology (K.A.T.), University of Kansas Medical Center, Kansas City, KS; the Department of Dermatology (D.M.), Baylor College of Medicine, Houston, TX; the Department of Diagnostic and Interventional Imaging (P.B.), University of Texas Health Sciences Center, Houston, TX; the Department of Dermatology and
| | - Maria Garzon
- From the Departments of Dermatology and Pediatrics (D.H.S., K.E.H., B.A.D.), Radiology (T.K., C.J., M.M.), and Dermatology (P.K.), Medical College of Wisconsin, Milwaukee, WI; the Department of Dermatology (K.A.T.), University of Kansas Medical Center, Kansas City, KS; the Department of Dermatology (D.M.), Baylor College of Medicine, Houston, TX; the Department of Diagnostic and Interventional Imaging (P.B.), University of Texas Health Sciences Center, Houston, TX; the Department of Dermatology and
| | - Christopher Hess
- From the Departments of Dermatology and Pediatrics (D.H.S., K.E.H., B.A.D.), Radiology (T.K., C.J., M.M.), and Dermatology (P.K.), Medical College of Wisconsin, Milwaukee, WI; the Department of Dermatology (K.A.T.), University of Kansas Medical Center, Kansas City, KS; the Department of Dermatology (D.M.), Baylor College of Medicine, Houston, TX; the Department of Diagnostic and Interventional Imaging (P.B.), University of Texas Health Sciences Center, Houston, TX; the Department of Dermatology and
| | - Ilona J. Frieden
- From the Departments of Dermatology and Pediatrics (D.H.S., K.E.H., B.A.D.), Radiology (T.K., C.J., M.M.), and Dermatology (P.K.), Medical College of Wisconsin, Milwaukee, WI; the Department of Dermatology (K.A.T.), University of Kansas Medical Center, Kansas City, KS; the Department of Dermatology (D.M.), Baylor College of Medicine, Houston, TX; the Department of Diagnostic and Interventional Imaging (P.B.), University of Texas Health Sciences Center, Houston, TX; the Department of Dermatology and
| | - Heather J. Fullerton
- From the Departments of Dermatology and Pediatrics (D.H.S., K.E.H., B.A.D.), Radiology (T.K., C.J., M.M.), and Dermatology (P.K.), Medical College of Wisconsin, Milwaukee, WI; the Department of Dermatology (K.A.T.), University of Kansas Medical Center, Kansas City, KS; the Department of Dermatology (D.M.), Baylor College of Medicine, Houston, TX; the Department of Diagnostic and Interventional Imaging (P.B.), University of Texas Health Sciences Center, Houston, TX; the Department of Dermatology and
| | - Beth A. Drolet
- From the Departments of Dermatology and Pediatrics (D.H.S., K.E.H., B.A.D.), Radiology (T.K., C.J., M.M.), and Dermatology (P.K.), Medical College of Wisconsin, Milwaukee, WI; the Department of Dermatology (K.A.T.), University of Kansas Medical Center, Kansas City, KS; the Department of Dermatology (D.M.), Baylor College of Medicine, Houston, TX; the Department of Diagnostic and Interventional Imaging (P.B.), University of Texas Health Sciences Center, Houston, TX; the Department of Dermatology and
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Alsuwaidan SN. PHACES syndrome in association with airway hemangioma: First report from Saudi Arabia and literature review. Ann Thorac Med 2012; 7:44-7. [PMID: 22347351 PMCID: PMC3277042 DOI: 10.4103/1817-1737.91555] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2011] [Accepted: 06/18/2011] [Indexed: 11/23/2022] Open
Abstract
“PHACES” is a neurocutaneous syndrome that refers to the following associations: Posterior fossa malformations, Hemangiomas, Arterial malformations, Coarctation of the aorta/Cardiac defects, Eye abnormalities, and Sternal defects. Herein, we report the association of PHACES syndrome with airway hemangioma, a serious association that should not be overlooked. The findings of such an association presented here are the first to be reported from Saudi Arabia.
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Affiliation(s)
- Sami N Alsuwaidan
- Department of Dermatology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Kim DH, Choi JH, Lee JH, Kim HS. PHACE association with intracranial, oropharyngeal hemangiomas, and an atypical patent ductus arteriosus arising from the tortuous left subclavian artery in a premature infant. KOREAN JOURNAL OF PEDIATRICS 2012; 55:29-33. [PMID: 22359528 PMCID: PMC3282216 DOI: 10.3345/kjp.2012.55.1.29] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2011] [Revised: 05/19/2011] [Accepted: 07/21/2011] [Indexed: 11/27/2022]
Abstract
PHACE association is a rare neurocutaneous condition in which facial hemangiomas associate with a spectrum of posterior fossa malformations, arterial cerebrovascular anomalies, cardiovascular anomalies, and eye anomalies. We reported a case of PHACE association in a premature infant showing facial, intracranial, and oropharyngeal hemangiomas with evidence of the Dandy-Walker variant and complicated cardiovascular anomalies, including a right-sided aortic arch and an atypical patent ductus arteriosus arising from a tortuous left subclavian artery. To our knowledge, intracranial hemangiomas are rare in PHACE association, and a concomitant oropharyngeal hemangioma has not been previously reported in the PHACE association literature. In infants presenting with large, plaque-like facial hemangiomas, it is important to conduct active cardiovascular and neurological evaluations. Special attention should be given to the laryngoscopic examination to search for additional hemangiomas in the airway.
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Affiliation(s)
- Do-Hyun Kim
- Department of Pediatrics, Dongguk University Ilsan Hospital, Goyang, Korea
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Meckel S, Spittau B, McAuliffe W. The persistent trigeminal artery: development, imaging anatomy, variants, and associated vascular pathologies. Neuroradiology 2011; 55:5-16. [PMID: 22170080 DOI: 10.1007/s00234-011-0995-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2011] [Accepted: 11/29/2011] [Indexed: 10/14/2022]
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Limb-shaking transient ischemic attacks in an adult PHACE syndrome: a case report and review of the literature. Neurol Sci 2011; 33:305-7. [PMID: 21710124 DOI: 10.1007/s10072-011-0671-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Accepted: 06/15/2011] [Indexed: 10/18/2022]
Abstract
PHACE syndrome is a neuro-cutaneous syndrome characterized by malformations of the Posterior fossa, facial Hemangiomas, Arterial anomalies, Cardiac anomalies, and abnormalities of the Eye. The arterial abnormalities usually involve the cervical and cerebral vasculature and include congenital abnormalities and progressive cerebral vasculopathy. The progressive cerebral vasculopathy leads to increased risk for arterial ischemic stroke (AIS) in patients with PHACE syndrome. Here we described the clinical neurological sequelae, the malformation of brain, the cervical and cerebral vasculopathy in a 23-year-old female of PHACE syndrome. Besides, she presented AIS with limb-shaking transient ischemic attack, a rare clinical presentation of AIS in patients of PHACE syndrome.
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Arora SS, Plato BM, Sattenberg RJ, Downs RK, Remmel KS, Heidenreich JO. Adult presentation of PHACES syndrome. Interv Neuroradiol 2011; 17:137-46. [PMID: 21696650 DOI: 10.1177/159101991101700201] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Accepted: 04/02/2011] [Indexed: 01/06/2023] Open
Abstract
A significant percentage of children with hemangiomas may have PHACES syndrome which refers to the association of posterior fossa malformations, facial hemangiomas, arterial cerebrovascular abnormalities, cardiovascular anomalies, eye abnormalities and ventral defects like sternal clefting or supraumbilical raphe. A variety of factors have led to under diagnosis of PHACES syndrome in the past including lack of awareness and limited imaging modalities. Also, patients with PHACES syndrome with arterial cerebrovascular abnormalities can present with acute ischemic stroke. However, these patients usually present before one year of age. We describe a 29-year-old woman with no history of cerebrovascular disease who initially presented with symptoms of a stroke and was subsequently diagnosed to have PHACES syndrome exhibiting an array of multiple unusual imaging findings. We also discuss the current literature and recommendations about PHACES syndrome.
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Affiliation(s)
- S S Arora
- Department of Radiology, University of Louisville, KY, USA
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Prada F, Mortera C, Bartrons J, Rissech M, Jiménez L, Carretero J, Rovira C, Vicente MA. Complex aortic coarctation and PHACE syndrome. Rev Esp Cardiol 2011; 63:1367-70. [PMID: 21070732 DOI: 10.1016/s1885-5857(10)70261-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In PHACE syndrome, the acronym PHACE stands for the association of posterior fossa malformations, cervicofacial hemangiomas, arterial anomalies, coarctation and eye anomalies. We report our findings in four patients with this syndrome, in whom it was characterized by complex aortic coarctation that required not only preoperative echocardiographic investigation, but also the use of techniques such as magnetic resonance imaging and angiography. Surgical treatment was also complex. Prognosis in this condition depends primarily on cardiovascular and cerebral artery complications associated with the syndrome.
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Affiliation(s)
- Fredy Prada
- Servicio de Cardiología, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain.
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Prada F, Mortera C, Bartrons J, Rissech M, Jiménez L, Carretero J, Rovira C, Vicente MA. Coartación aórtica compleja y síndrome de PHACE. Rev Esp Cardiol 2010. [DOI: 10.1016/s0300-8932(10)70306-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Hess CP, Fullerton HJ, Metry DW, Drolet BA, Siegel DH, Auguste KI, Gupta N, Haggstrom AN, Dowd CF, Frieden IJ, Barkovich AJ. Cervical and intracranial arterial anomalies in 70 patients with PHACE syndrome. AJNR Am J Neuroradiol 2010; 31:1980-6. [PMID: 20705698 DOI: 10.3174/ajnr.a2206] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND AND PURPOSE Cerebral and cervical arterial abnormalities are the most common non-cutaneous anomaly in PHACE syndrome, but the location and type of arterial lesions that occur have not been systematically assessed in a large cohort. Our aim was to characterize the phenotypic spectrum of arteriopathy, assess the frequency with which different arteries are involved, and evaluate spatial relationships between arteriopathy, brain structural lesions, and hemangiomas in PHACE syndrome. MATERIALS AND METHODS Intracranial MRA and/or CTA images from 70 children and accompanying brain MR images in 59 patients with arteriopathy and PHACE syndrome were reviewed to identify the type and location of arterial lesions and brain abnormalities. Five categories of arteriopathy were identified and used for classification: dysgenesis, narrowing, nonvisualization, primitive embryonic carotid-vertebrobasilar connections, and anomalous arterial course or origin. Univariate logistic regression analyses were performed to test for associations between arteriopathy location, hemangiomas, and brain abnormalities. RESULTS By study design, all patients had arterial abnormalities, and 57% had >1 form of arteriopathy. Dysgenesis was the most common abnormality (56%), followed by anomalous course and/or origin (47%), narrowing (39%), and nonvisualization (20%). Primitive embryonic carotid-vertebrobasilar connections were present in 20% of children. Hemangiomas were ipsilateral to arteriopathy in all but 1 case. The frontotemporal and/or mandibular facial segments were involved in 97% of cases, but no other specific associations between arteriopathy location and hemangioma sites were detected. All cases with posterior fossa anomalies had either ICA anomalies or persistent embryonic carotid-basilar connections. CONCLUSIONS The arteriopathy of PHACE syndrome commonly involves the ICA and its embryonic branches, ipsilateral to the cutaneous hemangioma, with dysgenesis and abnormal arterial course the most commonly noted abnormalities. Brain abnormalities are also typically ipsilateral.
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Affiliation(s)
- C P Hess
- Department of Radiology, University of California, San Francisco, 94143-0628, USA.
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Krings T, Geibprasert S, terBrugge K. Classification and Endovascular Management of Pediatric Cerebral Vascular Malformations. Neurosurg Clin N Am 2010; 21:463-82. [DOI: 10.1016/j.nec.2010.03.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Xie T, Zhang XB, Li QP, Zhu W, Zhou H, Gu Y. Hemifacial spasm patient with ipsilateral total absence of common carotid artery, vertebral artery and aneurysm of the contralateral internal carotid artery. Surg Radiol Anat 2010; 32:707-10. [PMID: 20473496 DOI: 10.1007/s00276-010-0660-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2010] [Accepted: 03/23/2010] [Indexed: 11/24/2022]
Abstract
We present a case of a 45-year-old male patient with left hemifacial spasm for 6 years. Magnetic resonance tomographic angiography confirmed that there were small vessels adjacent to the left facial nerve root entry zone, but the left internal carotid artery (ICA) was absent. Magnetic resonance angiography using three-dimensional time of flight technique showed the absence of the left ICA and vertebral artery, But the presence of a 6-mm aneurysm in the bifurcation of the right internal carotid artery. These abnormal arterial structures were further confirmed by angiogram. Aortic arch angiogram revealed a right-sided aortic arch and the Subclavian steal phenomenon. The left common carotid artery and the left Subclavian artery were absent. Right vertebral angiography showed retrograde filling of the left vertebral artery. The left upper limb was fed by this artery. The aneurysm was successfully clipped. Post-operatively, the hemifacial spasm was weakened. However, the operation did not change the neurovascular positional relationship, thus we advised follow-up visits. Cerebral artery anomalies should be taken into consideration when performing imaging and surgical corrections in patients with hemifacial spasm.
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Affiliation(s)
- Tao Xie
- Department of Neurosurgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
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Pascual-Castroviejo I, Pascual-Pascual SI, Viaño J, López-Gutierrez JC, Palencia R. Major and minor arterial malformations in patients with cutaneous vascular abnormalities. J Child Neurol 2010; 25:587-98. [PMID: 19808986 DOI: 10.1177/0883073809340920] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The association of persistent embryonic arteries and the absence of 1 carotid or vertebral arteries with facial or neck hemangioma or vascular malformation have been frequently described. The abnormalities can involve major or minor vessels. Of 22 patients of our series with this neurocutaneous syndrome, 20 had the origin of both anterior cerebral arteries from the same internal carotid artery. Thirteen patients showed absence or hypoplasia of 1 carotid artery and 10 of 1 vertebral artery; 10 showed persistence of the trigeminal artery; 3 had persistent proatlantal artery; 6 showed the absence of the posterior communicating artery; and 4 had hypoplastic posterior cerebral artery. Other less frequent abnormalities were found in 7 patients. Intellectual level of most patients was either borderline or below normal. Abnormalities in the vascularization and perfusion of the frontal lobes may contribute to the borderline or lower mental level of these patients.
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Qian Y. A New Challenge to Estimate the Rupturing Process of ICA Aneurysms. Interv Neuroradiol 2010. [DOI: 10.1177/15910199100160s114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Y Qian
- Australian School of Advanced Medicine, Macquarie University, Sydney, Australia
- Neurosurgery Department, Jikei University School of Medicine, Tokyo, Japan
- Centre for Advanced Biomedical Science, Tokyo, Japan
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Barkovich AJ, Millen KJ, Dobyns WB. A developmental and genetic classification for midbrain-hindbrain malformations. Brain 2009; 132:3199-230. [PMID: 19933510 PMCID: PMC2792369 DOI: 10.1093/brain/awp247] [Citation(s) in RCA: 217] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2009] [Revised: 08/04/2009] [Accepted: 08/21/2009] [Indexed: 01/30/2023] Open
Abstract
Advances in neuroimaging, developmental biology and molecular genetics have increased the understanding of developmental disorders affecting the midbrain and hindbrain, both as isolated anomalies and as part of larger malformation syndromes. However, the understanding of these malformations and their relationships with other malformations, within the central nervous system and in the rest of the body, remains limited. A new classification system is proposed, based wherever possible, upon embryology and genetics. Proposed categories include: (i) malformations secondary to early anteroposterior and dorsoventral patterning defects, or to misspecification of mid-hindbrain germinal zones; (ii) malformations associated with later generalized developmental disorders that significantly affect the brainstem and cerebellum (and have a pathogenesis that is at least partly understood); (iii) localized brain malformations that significantly affect the brain stem and cerebellum (pathogenesis partly or largely understood, includes local proliferation, cell specification, migration and axonal guidance); and (iv) combined hypoplasia and atrophy of putative prenatal onset degenerative disorders. Pertinent embryology is discussed and the classification is justified. This classification will prove useful for both physicians who diagnose and treat patients with these disorders and for clinical scientists who wish to understand better the perturbations of developmental processes that produce them. Importantly, both the classification and its framework remain flexible enough to be easily modified when new embryologic processes are described or new malformations discovered.
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Affiliation(s)
- A James Barkovich
- Neuroradiology Room L371, University of California at San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143-0628, USA.
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Abstract
We describe two cases of PHACES syndrome that illustrate the importance of recognizing this rare syndrome. As children with this syndrome can present to general pediatricians, dermatologists, pediatric cardiologists, ophthalmologists, and neurologists, it is important that all are aware of the spectrum of associated abnormalities.
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Affiliation(s)
- Fiona Browne
- SpR Dermatology, Leeds General Infirmary, Leeds LS1 3EX, United Kingdom.
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Kirton A, deVeber G. Advances in perinatal ischemic stroke. Pediatr Neurol 2009; 40:205-14. [PMID: 19218034 DOI: 10.1016/j.pediatrneurol.2008.09.018] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2008] [Revised: 08/08/2008] [Accepted: 09/17/2008] [Indexed: 01/01/2023]
Abstract
Increasingly distinct patterns of focal ischemic injury in the fetal and perinatal brain are recognized. Improved classification has afforded advances in risk factor identification, pathophysiology hypotheses, outcome prediction, and potential avenues for intervention. Cerebrovascular occlusion leading to perinatal stroke may be arterial or venous, symptomatic or subclinical, and it can occur across multiple time frames. Distinguishing causative factors from mere associations represents a major challenge with important implications for studies of pathogenesis. The adverse outcomes suffered by most children highlight the need for further research. Reviewed here are the current understandings, recent advancements, and future directions for research in perinatal ischemic stroke.
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Affiliation(s)
- Adam Kirton
- Division of Neurology, Alberta Children's Hospital, Calgary, Alberta, Canada.
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40
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Hartemink DA, Chiu YE, Drolet BA, Kerschner JE. PHACES syndrome: a review. Int J Pediatr Otorhinolaryngol 2009; 73:181-7. [PMID: 19101041 DOI: 10.1016/j.ijporl.2008.10.017] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2008] [Revised: 10/02/2008] [Accepted: 10/07/2008] [Indexed: 02/07/2023]
Abstract
Large, segmental, cervicofacial hemangiomas are often associated with anomalies of intracranial, cardiovascular, and ophthalmic systems as well as ventral development.
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Affiliation(s)
- David A Hartemink
- Department of Otolaryngology and Communication Science, Medical College of Wisconsin, Milwaukee, WI, USA.
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41
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Abstract
Patients with the congenital neurocutaneous disorder PHACES are at a markedly increased risk of ischemic infarction during childhood. Although intracranial arterial anomalies have been well described, venous abnormalities have not been documented. The authors report on a unique case of a 3-month-old girl with PHACES and a skull base osteodural arteriovenous fistula. A separate arteriovenous shunt at T-5 may also have been present. Imaging findings and treatment strategies are discussed.
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Affiliation(s)
- Huan Wang
- Department of Neurosurgery, Children's Hospital Boston, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA
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42
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Abstract
A patient with a neurocutaneous disorder characterized by large facial infantile hemangiomas and associated abnormalities of the brain, cerebral vasculature, eyes, aorta, heart, and chest wall is presented. All children presenting with segmental infantile hemangiomas should undergo a complete diagnostic workup. We encourage a multidisciplinary clinical approach that minimally includes evaluations by dermatology, cardiology, ophthalmology, radiology, and neurology. The diagnosis of PHACES syndrome is confirmed in a child presenting with the characteristic facial hemangioma and at least 1 associated extracutaneous feature.
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Chung JI, Weon YC. Ophthalmic rete mirabile: the first angiographic documentation of embryonic ophthalmic collaterals in a patient with moyamoya disease. A case report. Interv Neuroradiol 2008; 14:293-6. [PMID: 20557726 DOI: 10.1177/159101990801400309] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2008] [Accepted: 07/01/2008] [Indexed: 11/16/2022] Open
Abstract
SUMMARY Plexiform vascular networks of the rete mirabile in humans are rare but can be observed in some vertebrates such as cobaye, cat, cow and sheep. Each set of embryonic arteries can be a potential source of these vascular networks which reconstitute the distal flows in segmental agenesis of internal carotid or vertebral arteries especially in patients with PHACE (posterior fossa malformation of the brain, facial hemangiomas, arterial anomalies, cardiac anomalies with coarctation of aorta, and eye abnormalities) syndrome. Ophthalmic rete mirabile has been found in some mammals such as camel, deer and avian species of pigeon, Hawaiian seabirds and deep-water fish of the cod other than human. We describe the first human case of ophthalmic rete mirabile confirmed on angiography in a patient with moyamoya disease. These findings are the first description in the English literature as far as we know. The clinical implications with moyamoya disease will be briefly discussed according to the embryologic development of cranial arteries.
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Affiliation(s)
- J I Chung
- Department of Radiology, Hanmaeum General Hospital; Jeju, Republic of Korea -
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Bijulal S, Sivasankaran S, Krishnamoorthy KM, Titus T, Tharakan JA, Krishnamanohar SR. Unusual coarctation-the PHACE syndrome: report of three cases. CONGENIT HEART DIS 2008; 3:205-8. [PMID: 18557884 DOI: 10.1111/j.1747-0803.2008.00193.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To report the clinical features, nature of vasculopathy observed and the management instituted in three cases of PHACE syndrome. RESULTS All three patients were noted to have diffuse vasculopathy and aortic arch hypoplasia in addition to aortic coarctation adding substantial surgical risk or making surgery palliative. CONCLUSION PHACE syndrome should be considered in the differential diagnosis of aortic coarctation associated with aortic arch hypoplasia.
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Affiliation(s)
- Sasidharan Bijulal
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.
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Oza VS, Wang E, Berenstein A, Waner M, Lefton D, Wells J, Blei F. PHACES association: a neuroradiologic review of 17 patients. AJNR Am J Neuroradiol 2008; 29:807-13. [PMID: 18223093 DOI: 10.3174/ajnr.a0937] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND AND PURPOSE We present neuroradiologic findings in 17 patients with posterior fossa malformations, hemangiomas, arterial anomalies, cardiac defects, eye abnormalities, and sternal or ventral defects (PHACES) association and identify those at highest risk of central nervous system (CNS) structural, cerebrovascular, and neurodevelopmental abnormalities. MATERIALS AND METHODS Patients with PHACES association were identified in the Vascular Anomalies Program at New York University Medical Center from 1998 to 2007. Many patients were followed in conjunction with other specialists at the Birthmark Institute at Roosevelt Hospital. Clinical records and imaging studies were reviewed retrospectively. Criteria for diagnosis of PHACES were based on previously published indicators. Imaging studies were independently re-reviewed by a neuroradiologist. Segmental mapping of cutaneous hemangioma distribution by photograph review and presence or absence of other PHACES-associated findings were correlated with radiologic findings. RESULTS Patients with large facial cutaneous (S1-S4) hemangiomas were especially at risk of CNS structural and cerebrovascular anomalies; S1 with ocular anomalies; and S3 with airway, ventral, and cardiac anomalies. All patients with CNS structural malformations had a cerebrovascular abnormality, and this cohort was at risk for developmental and/or other neurologic sequelae. Four patients had supratentorial CNS anomalies, including cortical dysgenesis and migration abnormalities. Some patients with CNS arteriopathy progressed to aneurysms. CONCLUSION Our data support and expand the work of others, identifying risk factors for segmental hemangiomas. In addition to posterior fossa CNS anomalies, supratentorial anomalies may be present in patients with PHACES, and this may correlate with significant clinical sequelae. The long-term prognosis of these patients remains unknown.
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Affiliation(s)
- V S Oza
- Department of Pediatrics, New York University School of Medicine, New York, NY 10016, USA
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Lasjaunias PL, Landrieu P, Rodesch G, Alvarez H, Ozanne A, Holmin S, Zhao WY, Geibprasert S, Ducreux D, Krings T. Cerebral proliferative angiopathy: clinical and angiographic description of an entity different from cerebral AVMs. Stroke 2008; 39:878-85. [PMID: 18239181 DOI: 10.1161/strokeaha.107.493080] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND PURPOSE The purpose of this article is to describe "cerebral proliferative angiopathy" (CPA) as a clinical entity, which may be regarded as separate from "classical" brain AVMs in angioarchitecture, natural history, clinical presentation, and, therefore, treatment and which can be discerned from other cerebral AVMs by characteristic imaging features. METHODS In a prospectively entered databank encompassing 1434 patients with brain AVMs, a subgroup of 49 patients harboring specific angiographic characteristics were identified. Their charts and imaging films were retrospectively reviewed. RESULTS We found a preponderance of CPA in young (mean age: 22) females (67%). Clinical symptoms were seizures, disabling headaches, and stroke-like symptoms; hemorrhagic presentations were exceptional. On cross-sectional imaging, CPA demonstrated as a diffuse network of densely enhancing vascular spaces with intermingled normal brain parenchyma. The discrepancy between the large size of the nidus and the small shunting volume, the absence of flow-related aneurysms, the presence of diffuse angiogenesis (eg, transdural supply, progressive arterial occlusion), and the small calibre of a multitude of feeding arteries and draining veins were the angiographic hallmarks of this disease. CONCLUSIONS The diffuse angiogenetic activity is presumably related to reduced perinidal perfusion and subsequent chronic cortical ischemia. Natural history demonstrates a low risk of hemorrhage. CPA may be regarded as a separate clinical entity different to "classical" cerebral AVMs, because normal brain is interspersed with the abnormal vascular channels increasing the risk of neurological deficit in aggressive treatments, which in the light of the natural history does not seem to be indicated.
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Affiliation(s)
- Pierre L Lasjaunias
- Service de Neuroradiologie Diagnostique et Thérapeutique, Hôpital de Bicêtre, 78, rue du Général Leclerc, 94275 Le Kremlin-Bicêtre, France.
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Heyer GL, Dowling MM, Licht DJ, Tay SKH, Morel K, Garzon MC, Meyers P. The cerebral vasculopathy of PHACES syndrome. Stroke 2008; 39:308-16. [PMID: 18174492 DOI: 10.1161/strokeaha.107.485185] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE PHACES syndrome is a neurocutaneous disorder of unknown etiology. We studied the spectrum of associated congenital and progressive cerebral vascular anomalies. METHODS The medical records of 7 patients with PHACES syndrome were reviewed and combined with an additional 108 PHACES cases identified from the literature. We reviewed the clinical characteristics, calculated the relative frequencies of each type of vascular anomaly, and assessed site of vessel involvement relative to hemangioma location. RESULTS Among a total of 115 PHACES cases, 89 (77.4%) had congenital and/or progressive cerebral vascular anomalies. The most commonly detected congenital arterial anomalies included dysplasia, aberrant origin or course, hypoplasia, and absence or agenesis. Arterial occlusions and stenoses were detected in 24 (20.9%) and 21 (18.3%) cases, respectively. Twenty (17.4%) had persistent embryonic arteries; 15 (13%) had saccular aneurysms. There appears to be a close relation between the regional distributions of cervicofacial hemangiomas and the locations of intracranial and extracranial vascular (and cardiac) anomalies. CONCLUSIONS The vasculopathy of PHACES chiefly comprises a spectrum of congenital and progressive large artery lesions. Based on known embryology and the relative frequencies of specific congenital vascular anomalies, we can predict that the initial cerebral vascular changes occur early in embryogenesis, by the fifth gestational week or earlier. There appears to be both a temporal and a regional link between the arterial anomalies of PHACES and the cutaneous infantile hemangioma.
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Affiliation(s)
- Geoffrey L Heyer
- Department of Neurology, Columbia University, New York, NY 10032, USA.
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Smoker WRK, Gentry LR, Yee NK, Reede DL, Nerad JA. Vascular Lesions of the Orbit: More than Meets the Eye. Radiographics 2008; 28:185-204; quiz 325. [DOI: 10.1148/rg.281075040] [Citation(s) in RCA: 107] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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49
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Metry DW, Siegel DH, Cordisco MR, Pope E, Prendiville J, Drolet BA, Horii KA, Stein SL, Frieden IJ. A comparison of disease severity among affected male versus female patients with PHACE syndrome. J Am Acad Dermatol 2008; 58:81-7. [DOI: 10.1016/j.jaad.2007.09.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2007] [Revised: 08/26/2007] [Accepted: 09/12/2007] [Indexed: 10/22/2022]
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Abstract
Stroke in children is relatively rare. Advances in the clinical recognition and radiographic diagnosis of ischemic stroke have increased the frequency of the diagnosis in infants and children and have raised the need for immediate therapy. A vast amount of data has recently become available through basic research and neuroimaging techniques shedding new light on the chain of events that occur in ischemic stroke in animal models and in the adult population. Whether this new information can also be applied to the pediatric population remains to be seen, but it is likely that the active management of children with acute ischemic stroke in the near future will include brain protection, brain reperfusion, and prevention measures.
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Affiliation(s)
- Tali Jonas Kimchi
- Division of Neuroradiology, Department of Medical Imaging, Sheba Medical Center, Ramat-Gan, Israel.
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